Hummel J R
Greensfelder, Hemker & Gale, P.C., St. Louis, Missouri, USA.
Healthc Financ Manage. 1999 Nov;53(11):42-6.
Providers considering managed care risk pool arrangements should understand thoroughly what services the pool covers, the time period covered, and how the pool is administered. Important issues related to pool administration include how credits and debits are applied; when the accounting occurs (interim, year-end, or contract termination); and provisions for reports, audit rights, and dispute resolution. Although a pool arrangement gives the health plan control over claims payment, the risk allocation made possible through a pool arrangement helps ensure that the economic incentives of the health plan and the provider are aligned.
考虑管理式医疗风险池安排的供应商应全面了解该风险池涵盖哪些服务、涵盖的时间段以及风险池的管理方式。与风险池管理相关的重要问题包括贷项和借项如何应用；会计核算何时进行（中期、年终或合同终止时）；以及报告、审计权和争议解决的规定。尽管风险池安排赋予了健康计划对理赔支付的控制权，但通过风险池安排实现的风险分配有助于确保健康计划和供应商的经济激励保持一致。
